3 Clinical Considerations for Working with Student-Athletes: Identity, Exercise, and Being “Fine”

Most clinicians will at some point work with student-athletes. There are many levels of athletic involvement, from children playing weekend soccer, to high school athletes juggling school teams, club teams, and extra training, to the college player trying to squeeze therapy between practice, classes, and lifts, to the professional basketball player (Knicks in 5!!!). We are bound to work with athletes in some capacity, yet most of us receive little (if any) training on their unique needs and how best to support them.

This topic is especially meaningful to me for two reasons: I played lacrosse in college, and I recently completed a research study examining the needs, risk factors, and help-seeking behaviors of college student-athletes.

Playing college lacrosse was an awesome experience (see me looking semi-athletic back in the day). I gained my best friends, met my husband (who played college soccer) through mutual sporty friends, and developed some pretty good time-management skills. At the same time, it was also demanding and required a lot of time and (mental and physical) energy.

We often describe student-athletes as disciplined, resilient, and tough (and I mean of course we are). But they are still adolescents and young adults navigating the same developmental complexities as their peers, while also managing big physical and time demands.

Wanting to better understand experiences beyond my own, I teamed up with other researchers to study student-athletes’ unique experiences.

In a sample of NCAA student-athletes, about 40% reported having had suicidal thoughts at some point in their lives. More than half of those experienced these thoughts while in college.

If they were struggling, fewer than half of student-athletes said they would reach out to friends, family, or teammates, and even fewer indicated they would turn to formal supports such as counseling centers, psychologists, coaches, or other athletic staff, suggesting relatively low overall help-seeking intentions across both informal and professional sources (Bond et al., 2026). 

We published this paper in an open access journal, so if you’re interested in learning more, you can check out the whole paper here.

These findings are concerning, particularly the low likelihood of reaching out to psychologists or other formal support systems. While we don’t know exactly why this is the case, one possible explanation is that, as clinicians, we receive little training in working with student-athletes and may not always provide the kind of help they need.

So, what should clinicians consider when working with student-athletes? 

Here are a few thoughts:

1. Athletic Identity and Transitions

Remember those college icebreaker introductions? Name, major, and a fun fact. Mine was always: “Hi, I’m Allie, I’m a psychology major, and I play lacrosse.” Even though I was basically always walking into class wearing a university lacrosse t-shirt (and sometimes with ice wrapped on some body part from morning practice) so that fun fact wasn’t surprising or fun for anyone.

Being an athlete wasn’t just something I did, it was who I was. And that’s really common for athletes. Sport becomes a huge part of identity. It gives structure, belonging, community, and a clear sense of “this is my role.” That can be really protective! But it also means that when sport gets disrupted, things can feel bigger than just a schedule change.

Role vs. Identity

It can be hard to distinguish between one’s athletic role and one's broader identity. The role of being an athlete (“I play lacrosse”) is tied to participation in a specific context and will eventually change or end. However, many of the qualities athletes associate with that role, like discipline, teamwork, perseverance, leadership, and commitment, are not confined to sport. These aspects of identity can continue on and be carried forward into other areas of life.

Navigating Transitions

Some transitions are expected, like graduating or finishing up your eligibility. Others are less planned, like major injuries, being benched, or losing a roster spot. 

Injury, for example, represents much more than physical downtime. It’s a loss of structure, daily routine, and the team environment. For some athletes, this major disruption opens the door to therapy in a really good way, as they may recognize the need for help coping with this change.  For others, it comes with frustration, grief, and a sense of losing control without any support.

Expected transitions, like graduation, can hit hard too, leading athletes to wrestle with: If I’m not an athlete anymore, then who am I?

Clinical Considerations

Support identity expansion before transitions occur

While athletes are still engaged in sport, we can help them explore other roles, relationships, and interests outside of athletics. This does not mean taking away the importance of their sport, but rather broadening their sense of self so that identity is not entirely contingent on participation.

Transitions are also great opportunities to slow down and better understand what sport means to our client and what parts they may be grieving

Questions to explore:

• What does the sport mean to you?

• What has it been like not being able to practice? 

• What do you miss most?

• How has your daily routine changed?

• Are you still spending time with teammates, or have you become disconnected from that support system?

• Have you found other ways to spend your time?

  
  

Then, we can help them rebuild a sense of routine, connection, and purpose.

The conversations can also become opportunities to explore values and strengths:

• What parts of being an athlete feel most important to you?

• Which of those strengths show up in other areas of your life? 

• What values do you want to carry into the next chapter, regardless of sport participation?

  
  

Finally, remember that these transitions are rarely one-and-done events. Recovery from an injury or figuring out life after graduation can take weeks or even months.

Rather than treating the transition as something that's "over," continue checking in over time. Simply naming that they're going through a major life transition, and that it's normal for it to feel disorienting, can help athletes make sense of what they're experiencing instead of feeling like they're "handling it badly."

2. Exercise Expectation and Forgetting What is Normal

One thing that can be tricky when working with student-athletes is that a lot of behaviors that might raise an eyebrow in other clients are…kind of normal in sports. Training multiple hours a day? Of course. Tracking food? Can be common. Pushing through injury and discomfort? Literally encouraged.

It can be hard to know when something has crossed the line from dedication into something more concerning. 

This is especially true when it comes to exercise and diet. I didn’t have weigh-ins in college or work with a nutritionist, but a lot of athletes do. There can be  pressure to maintain weight, eat certain ways, and put your body through a lot to perform at your best. Many athletes navigate these expectations without difficulty, but for those predisposed to disordered eating or compulsive exercise, this can trigger or reinforce unhealthy thoughts or behaviors. 

Clinical Considerations

Understand the context

One of the challenges of working with student-athletes is walking a careful line.

We don’t want to assume a behavior is healthy simply because it’s common or expected within a particular sport or team culture. At the same time, we don’t want to pathologize behaviors simply because they look unusual outside of sports.

This means we need to carefully assess how team expectations, coaching norms, and performance incentives shape behavior, and what function the behavior is serving for the athlete within that system. 

Our job is to understand the context, validate the real demands athletes face, and intervene when those behaviors begin to compromise physical or psychological well-being.

Spend some time understanding your client’s sport:

• What does a typical training week look like?

• What are the expectations around conditioning?

• Are there weigh-ins or nutrition requirements?

• How does the coach approach rest and recovery?

  
  

The goal isn't for you to become an expert in every sport, but to understand what is expected of this athlete before deciding what falls outside of those expectations.

Explore the function of the behavior

Once you understand the context, start exploring what function the behavior is serving.

Questions to consider:

• How do you feel if you have to miss a workout?

• What goes through your mind if your coach tells you to take a rest day?

• What feels hardest about taking a break?

  
  

The answers to these questions can tell us a lot. Is the athlete disappointed because they want to earn a starting spot and worried a rest day will prevent that? Or are they overwhelmed with guilt, anxiety, or fear that they're somehow failing?

Ultimately, helping athletes distinguish between training to improve performance and training that's being driven by anxiety, perfectionism, or fear can become an important treatment goal. 

When “Normal” Isn’t Healthy

It's also important to remember that athletes may not recognize some worrisome behaviors because they've become so normalized within sports. Sometimes you're the first person to question whether those thoughts or routines are actually serving them.

When a behavior fits within coach expectations or team culture but still appears physically or psychologically unhealthy, work to understand the power dynamics at play, clarify risks and long-term sustainability, and collaboratively identify options that protect your patient while balancing real costs (e.g., less playing time) of behavior change.

Finally, don't forget that exercise is often a coping skill for many of us (athlete or not). Part of our job is helping them build other coping strategies to manage distress, rather than expecting them to simply "take a break."

3. “I’m Fine”

One thing you’ll hear a lot from athletes is some version of: “I’m fine.” And sometimes we really are, we’re totally fine. But other times, this is our automatic response and it really means, “I’m exhausted,” “I’m overwhelmed,” or “I’m struggling, but I’m used to pushing through it.”

From a young age, athletes are taught to push through. You finish the drill. You run all the way through the line. You play through soreness. You don’t want to let your teammates down. You don’t want to lose your spot.

Honestly, a lot of those lessons are incredibly adaptive in sports and life.

Athletes often play through pain, downplay injuries, and return to play earlier than maybe they should. Physical discomfort is almost expected. It’s normal to need ice after practice, to be sore during pre-season, and to have the athletic trainer tape up your ankle before every game (like my husband his entire college soccer career). 

And when physical discomfort is normalized for so long, mental and emotional pain often becomes so too.

Mental health concerns are still heavily stigmatized in our society, and even more so in athletics. So not only are athletes up against recognizing when they’re experiencing mental or emotional discomfort, but they also have to decide whether it’s safe to say something about it. 

Admitting you’re “not fine” can feel like it carries real consequences: you don’t start anymore, you lose playing time, or you risk being seen differently by coaches and teammates.

So many athletes become incredibly skilled at minimizing what they’re experiencing. They tell themselves they should be able to handle it or wait until things feel completely unmanageable before asking for help. Add in the fear of letting others down, and “I’m fine” becomes a coping strategy, a way to maintain the “tough” identity they’ve worked hard to build, and in turn delays needed treatment.

Clinical Considerations

Don’t accept “I’m fine” at face value

One of the most useful things we can do is not accept “I’m fine” as the end of the conversation. Instead, get curious about what hasn’t been “fine” recently. Let’s be honest, life is hard, so we all should have answers to these questions beyond the word “fine."

Questions to explore:

• “What’s actually been feeling hardest lately?”

• “What’s something your teammates wouldn’t know just by looking at you?”

• “Where in your life are you pushing through the most right now?”

• “What makes it harder to say you’re not doing okay?”

  
  

Build a language for emotional distress

Part of our role is also helping athletes distinguish between physical pain norms in sport and emotional distress that deserves attention. They may already have a well-developed vocabulary for injury and recovery, but much less experience naming or responding to emotional difficulties. Helping athletes put these experiences into words can make them easier to understand, manage, and communicate to others.

Normalize help-seeking

And finally, it can be helpful to normalize help-seeking in a way that actually fits their world. Getting treatment for a torn ACL is seen as responsible and expected. Mental health care can be framed in a similar way, not as something separate from sport, but as another form of recovery that helps them stay well, function better, and continue doing what matters to them.

Closing Thoughts for Working with Student-Athletes

Working with student-athletes is fun. They're determined, dedicated, and so competent. As clinicians, we need to remember that we aren’t just treating symptoms in isolation, we’re working with people who are embedded in a very specific culture. One that rewards pushing through and normalizes discomfort.

Across identity, exercise, and the constant “I’m fine,” a common thread is that athletes are incredibly good at adapting to what is asked of them. That’s part of what makes them successful! But those same strengths can also make it harder to notice when something has shifted from adaptive to overwhelming. 

We don’t need to become experts in every sport or fully understand every training schedule. But we do need to stay curious about what the sport means in our clients’ lives – what it costs them, what it gives them, and what gets lost in the process of trying to perform and keep up. 

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